Provider Demographics
NPI:1639375561
Name:FORD BIO MEDICAL LABORATORY INC.
Entity Type:Organization
Organization Name:FORD BIO MEDICAL LABORATORY INC.
Other - Org Name:FORD BIO MEDICAL LABORATORY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULHAK
Authorized Official - Suffix:
Authorized Official - Credentials:LAB DIRECTOR
Authorized Official - Phone:313-581-9295
Mailing Address - Street 1:5601 SCHAEFER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4713
Mailing Address - Country:US
Mailing Address - Phone:313-581-9295
Mailing Address - Fax:
Practice Address - Street 1:5601 SCHAEFER RD STE 200
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4713
Practice Address - Country:US
Practice Address - Phone:313-581-9295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N22250Medicare PIN